Prevention of veno-occlusive disease with defibrotide after allogeneic stem cell transplantation

Article Article scientifique Article Prevention of veno-occlusive disease with defibrotide after allogeneic stem cell transplantation eng 2004 author Chalandon Yves 644957 author Roosnek Eddy Emile 27236 author Mermillod Bernadette 22748 author Newton Anita Marie 54918 author Ozsahin Ayse Hulya 121635 author Wacker Pierre 23992 author Helg Claudine 132492 author Chapuis Bernard 24001 347-354 10.1016/j.bbmt.2004.01.002 15111934 1083-8791 Veno-occlusive disease (VOD) of the liver occurs in 10% to 50% of patients after allogeneic stem cell transplantation, ranging from mild reversible disease to severe disease, with a mortality rate almost always close to 100%. Recently, promising results in the treatment of established VOD with defibrotide were reported. Therefore, defibrotide may be used as a prophylactic regimen for hepatic VOD in stem cell transplantation for hematologic malignancies. Fifty-two successive patients who underwent transplantation between October 1999 and June 2002 received defibrotide prophylaxis intravenously from day -7 to day +20 after transplantation in addition to heparin and were compared with historical controls who underwent transplantation successively between February 1997 and September 1999. In the defibrotide group, the maximum total bilirubin levels and the number of patients with serum levels exceeding 50 micromol/L were significantly lower than in the control group (5 of 52 versus 18 of 52, respectively; P =.004). None of the 52 patients developed VOD (Baltimore criteria), and no side effects occurred. These results were significantly different (P =.001) from controls (10/52 [19%] with VOD, 3 of whom died of severe VOD). In addition, day 100 event-free survival was significantly higher in the study group (P =.02), with a trend toward better day 100 overall survival (P =.07). These results suggest that defibrotide given in addition to heparin may be an efficient prophylaxis for VOD. Adolescent Adult Bilirubin/blood Cause of Death Child Child, Preschool Drug Therapy, Combination Female Fibrinolytic Agents/administration & dosage Graft vs Host Disease Hematopoietic Stem Cell Transplantation/adverse effects/methods/mortality Heparin/administration & dosage Hepatic Veno-Occlusive Disease/etiology/mortality/prevention & control Humans Male Middle Aged Polydeoxyribonucleotides/administration & dosage Survival Analysis Transplantation, Homologous Dewey 616 Dewey 618 56 Département de médecine 221 58 Département de pédiatrie, gynécologie et obstétrique 223 false 14 Groupe Roosnek Eddy (hémato-oncologie) 19 Biology of blood and marrow transplantation 10 5 dcd7259a-fceb-4ff1-9b72-47f1110a4d95 Article (Published version) Restricted 347-354.pdf 143022 application/pdf restrictedAccess Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique

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Prevention of veno-occlusive disease with defibrotide after allogeneic stem cell transplantation	Biology of blood and marrow transplantation			2004	622	0

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Newton, Anita Marie